Please contact us if you need assistance throughout the application process.
(If YES, you must attach exemption certificates with this form)
All statements made herein are true and accurate to the best of my/our knowledge. The above company and its agents are authorized to make a credit investigation and are hereby indemnified from any liability resulting from their credit survey. I/we agree to pay a late charge totaling up to the amount permitted by law in your state on any delinquent balance. I/we agree to pay reasonable attorney fees and costs if legal action is necessary to collect any sums due on this account or under the guarantee hereof. In the event that any legal action is required to collect on this account, venue for such legal matters will be within the State of Texas. If you do not want us to share credit information about you, please submit that request in writing to: Pilot Thomas Logistics, 201 N Rupert St Fort Worth, TX 76107 Attn: Credit.I understand and acknowledge that this credit application, the authorization, and all terms and conditions apply to any transactions conducted with all subsidiaries such as Thomas Petroleum, LLC, Pilot Thomas Logistics, LLC, General Petroleum Corporation, Rainier Petroleum Corporation, Simons Petroleum, LLC, Maxum Petroleum, Inc. and Petroleum Products, LLC. Notwithstanding that this account is established in the name of a company, I personally guarantee payment of the account.
You are required to sign and attach the W-9 form, which can be downloaded by clicking here. If you require forms for exemptions, please contact your sales representative directly, this application package will not apply. Your Account will not be exempted from taxes.
***Please ensure that your W-9 has been signed and dated within the last year.***
This information must be provided to ensure your account is set up with the proper contact information.
Payment terms will come from seller's credit department upon approval.
Product(s) to be purchased:
**Upload certificate for Dyed Diesel below.**